Tests Needed To Identify Heart Disease

Q-Could you please explain a bit about tests that I may be facing with a diagnosis of coronary heart disease? Do any of them cause pain, or are they dangerous? I`m more than a little anxious.

A-Coronary heart disease is the No. 1 cause of death in the U.S. It is the most common form of heart disease, and because treatment is based on knowing the extent of your problem, testing is very important.

Coronary artery disease is a condition in which the muscle tissue of the heart is not receiving enough oxygen. The heart can`t take any oxygen from the blood that it pumps.

It gets its own supply through the coronary arteries, a set of arteries that encircles the heart and resembles a crown (coronary means crown-like). When these arteries become clogged, blocked or narrowed, heart tissue dies from lack of oxygen, and a myocardial infarction, or heart attack, occurs. A gradual narrowing, or spasm, of these arteries causes the chest pain known as angina.

Your doctor will decide which tests to use to diagnose coronary heart disease based on several factors, the most important of which is your symptoms. If you feel chest pain on exertion or if you`ve suffered a heart attack, your doctor will probably have you undergo several tests.

(a very small tube) is placed into a vein or artery and used to inject a contrast medium (which shows up on X-ray), or to measure pressures in the vessel. Invasive tests are more reliable than non-invasive tests, but they are more expensive and carry some risk.

Non-invasive tests include stress or exercise testing, where you walk or run on a treadmill while an electrocardiogram is taken. Your doctor will evaluate how your electrocardiogram changes as exercise stresses your heart. This is an easy, relatively inexpensive test and will probably be the first you undergo.

You may need additional tests that can give more information about the condition of your heart.

Some of these tests require an injection with small amounts of radioactive materials. The amount of radioactivity is low, and it passes out of your body quickly.

In exercise echocardiography, your doctor will look at an ultrasound picture of your heart as you exercise. Ultrasound works on the same principle that sonar does, and it`s quite safe.

Based on results from non-invasive tests, your physician may ask you to undergo an invasive test for coronary artery disease. The most common one is cardiac catherization. A catheter is placed in a small blood vessel and, under local anesthesia, is snaked along into your heart, where a great deal of information about the way your heart pumps blood can be gathered.

This procedure is considered a minor operation and has some risks, but it gives your doctor the best information about your coronary arteries.

It may seem like a long and complicated process, and it is. Expensive too. But it provides all the necessary information that helps the physician help you choose the right therapy to fight your heart disease.

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Dr. Bruckheim welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Bruckheim c/o the Chicago Tribune, P.O. Box 119, Orlando, Fla. 32802-0119.